| NPI | 1003100249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX P6640) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61542956) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD219275) | |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2025-01-29 |